Epidural catheter migration and extra-spinal drug delivery: a possible cause of inflammation and/or infection

Abstract

Purpose: There is a strong possibility that many problems associated with local anaesthetics go undocumented. We describe an epidural catheter complication and its consequence. Clinical features: Female 56 year old patient operated 45 days previously for open gastric by-pass surgery and re-admitted to hospital because of pain and an infection related with the epidural technique. Lumbar Magnetic Resonance Imaging (MRI) revealed paravertebral inflammatory/infectious changes from L1 to L5, after lumbar epidural and post-operative epidural drug delivery for analgesia control. Intravenous antibiotic treatment and bed rest was continued for 21 days and a control MRI pointed to an improvement in the para-spinal alterations. There were never any signs of neurological deficit. We analyze, consider and discuss the clinical presentation of infectious complications of epidural anaesthesia, evaluating the various factors which might have led to this complication, as a silent migration of the catheter to a para-spinal region and the unintentional delivery of the drug involved, a foreign body reaction to the catheter tip or a result of the inflammatory process. Conclusions: An early diagnosis based on a combination of physical examination, imaging studies and appropriate follow up of those patients would avoid severe complications. In order to reduce the risk of serious infection following epidural anesthesia, the clinician must be knowledgeable in the pathogenesis of these infections, and use of meticulous aseptic technique and post operative regular assessment of the patient (as a routine) to look for effective analgesia, motor block, catheter migration etc. The right fixed-catheter manoeuvre and use of the correct pumps delivery system are clearly indicated. Treatment must be initiated as soon as there is any suspicion of an infection related with a spinal technique and that prevention is the best alternative.